Strategic Program Integrity Contract Lead (Remote)

Humana Inc; Salt Lake City (UT); Remote; USD 95,000 - 131,000; Full time

Job summary

Humana Inc. is seeking a PI Contract Lead to join our remote team and support compliance with healthcare contracts and regulations. You will translate requirements into actionable processes, monitor performance, and drive improvements using Lean and Six Sigma methodologies.

You will collaborate with senior leadership and cross-functional teams to address risks, develop corrective actions, and ensure regulatory alignment across programs.

Qualifications

• Five or more years of Program Integrity and/or Payment Integrity experience.
• Two or more years of project management experience, ideally in large contracts.
• Must have ONE of the listed anti-fraud degrees, designations, or certifications.
• Experience with claims adjudication, systems and reporting.
• Knowledge in healthcare related applications and technology.
• Ability to manage multiple initiatives with minimal guidance.
• Excellent communication and presentation skills for executive audiences.
• Results-driven mindset to meet individual and organizational goals.

Responsibilities

• Translate contract requirements into business processes, workflows, and controls.
• Develop implementation workplans, milestones, dependencies, risks and readiness criteria.
• Identify operational gaps and propose changes to meet contractual requirements.
• Establish and maintain a contract monitoring framework for compliance.
• Apply Lean, Six Sigma, root-cause analysis to improve performance.
• Conduct routine reviews to ensure alignment with contractual obligations.

Skills

Program Integrity

Project management

Communication skills

Analytical thinking

Root cause analysis

Education

RN/BSN or CPC/CCS/CCDS/CHC/HCAFA/AHFI/CFE/JD

Tools

Excel

PowerPoint

Word

Job description

Humana Inc. is seeking a PI Contract Lead to join our remote team and support compliance with healthcare contracts and regulations. You will translate requirements into actionable processes, monitor performance, and drive improvements using Lean and Six Sigma methodologies.

You will collaborate with senior leadership and cross-functional teams to address risks, develop corrective actions, and ensure regulatory alignment across programs.